Pancreatic islet-like cell structures and a method of preparing thereof

ABSTRACT

The invention relates to a method of preparing pancreatic islet-like cell structures characterized by a unique combination of morphological and functional features which make them particularly suitable for use in both clinical and drug screening application, as well as to the pancreatic islet-like cell structures obtained therefrom.

The present invention relates to the field stem cell differentiation. Inparticular, the present invention relates to a method fordifferentiating a stem cell into a pancreatic islet-like cell structureand to the pancreatic islet-like cell structure obtained therefrom.

Type 1 diabetes is a disease with a huge socio-economic impact that, ifuntreated, leads to death. It is caused by autoimmune destruction ofpancreatic insulin producing cells (β-cells) and associated with thedevelopment of debilitating microvascular and macrovascularcomplications.

Both pancreas transplantation and islets transplantation have been shownto restore islets function and potentially reduce long-term diabeticcomplications, but are limited by both donor shortage and the need forimmunosuppression. In this context, stem cells represent a promisingsource for the generation of insulin-producing cells, as they may haveproperties that allow to satisfy the requirements for the cure of type 1diabetes mellitus (T1DM). Firstly, they may allow both to restore β-cellfunction and prevent recurrence of autoimmunity, without the need ofusing immunosuppressive therapy. Secondly, due to their potentiallyunlimited capacity for self-renewal, they could be broadly used.

In vitro methods to generate, under specific culture conditions,islets-like structures from human embryonic stem cells (Kroon E et al.Nat Biotechnol. 2008; 26(4): 443-52; Rezania A et al. Diabetes. 2012;61(8): 2016-29; Bose B et al. Cell Biol Int. 2012; 36(11): 1013-20),human adipose tissue-derived stem cells (Mohamad Buang M L et al. ArchMed Res. 2012; 43(1): 83-8; Chandra V et al. PLoS One. 2011;6(6):e20615), nestin-positive cells derived from bone marrow (Milanesi Aet al. J Endocrinol. 2011; 209(2); 193-201), stem cells isolated fromhuman amniotic fluid and dental pulp (Carnevale G et al. Dig Liver Dis.2013; 45(8): 669-76), and human umbilical cord blood-derived mesenchymalstem cells (Prabakar K R et al. Cell Transplant. 2012; 21(6): 1321-39)are disclosed in the prior art.

However, islets-like structures derived in vitro from human embryonicstem cells were found to be immature, thus requiring a further in vivo3-to-4 month differentiation period in order to become mature functionalislets (Kroon E et al. Nat Biotechnol. 2008; 26(4): 443-52; Rezania A etal. Diabetes. 2012; 61(8): 2016-29). Furthermore, one study reporting 3Din vitro generation of insulin secreting cells from human embryonic stemcells, while showing a stable trend to a decrease in glycaemia from 300mg/dl to 200 mg/dl, did not demonstrate, with the exception of insulin,protein expression of other hormones usually produced within thepancreatic islets (glucagon, pancreatic polypeptide (PP), somatostatinand ghrelin) (Bose B et al. Cell Biol Int. 2012; 36(11): 1013-20).

Insulin-producing cells generated in vitro from human adiposetissue-derived stem cells (Mohamad Buang M L et al. Arch Med Res. 2012;43(1): 83-8; Chandra V et al. PLoS One. 2011; 6(6):e20615),nestin-positive cells derived from bone marrow (Milanesi A et al. JEndocrinol. 2011; 209(2); 193-201), stem cells isolated from humanamniotic fluid and dental pulp (Carnevale G et al. Dig Liver Dis. 2013;45(8): 669-76) were shown to release human insulin in response toglucose stimulation in vitro. However, expression of glucagon, PP andghrelin was not demonstrated.

Insulin-producing cells generated from human umbilical cordblood-derived mesenchymal stem cells (CB-MSC) were shown to expressinsulin, C-peptide, glucagon and pancreatic polypeptide and to releaseC-peptide in response to glucose stimulation in vitro. However, theability of such cells to reduce blood glucose in experimental diabeteswas not demonstrated, as the authors only showed in vivo differentiationof engrafted CB-MSC-derived pancreatic endodermal cells into functionalendocrine cells with detection of low levels of C-peptide followingglucose challenge 60 days after the implantation (Prabakar K R et al.Cell Transplant. 2012; 21(6): 1321-39).

Methods of differentiation of human liver stem cells (HLSCs) intopancreatic islet cells are disclosed in Herrera M B et al. Stem Cells.2006; 24(12):2840-50 and in International patent application WO2006/126236.

In Herrera M B et al. Stem Cells. 2006; 24(12):2840-50, HLSCs were shownto change their elongated morphology into small spheroid cell clusters,morphologically resembling pancreatic islets, when cultured in DMEM withhigh glucose content (23 mM) for a month followed by 5-7 days of culturein the presence of 10 mM nicotinamide. Such spheroid cell clusters werepositively stained for human insulin and Glut2 and became positivelystained with the zinc-chelating agent dithizone, which is specific forinsulin-containing granules, suggesting the differentiation of HLSCsinto islet-like structures. Despite such exciting results, thedifferentiation protocol was limited by a low efficiency, particularlyreferring to both the quantity of the generated structures and the timerequired for generating them. Furthermore, even after extensiveculturing the structures did not quite grow to a size and morphologyclosely resembling human pancreatic structures.

In order to overcome the drawbacks of the prior art, the presentinventors have provided a new method of preparing a spheroid pancreaticislet-like cell structure, which is defined in the appended claims. Thecontent of the claims forms an integral part of the description.

Compared to the prior art, not only the method according to the presentinvention is simpler, faster and more efficient, but it also results instructures which more closely resemble natural human pancreatic isletstructures both in size and morphology. It results in the generation ofa higher number of pancreatic islet-like cell structures which,advantageously, have a diameter comparable to the naturally-occurringhuman pancreatic islets and which express, at the protein level, all ofthe hormones which are usually produced by human pancreatic islets (i.e.insulin, glucagon, PP, somatostatin and ghrelin). Moreover, followingimplant under the kidney capsule of streptozotocin-induced diabetic SCIDmice, the pancreatic islet-like cell structures obtainable by the methodof the present invention are capable of reducing blood glucose levelssignificantly early (within 13 days), with a concomitant increase inhuman C-peptide. To the inventors' knowledge, such strong similarity ofstructural features to natural human pancreatic islet structures renderunique the pancreatic islet-like cell structures generated with themethod of the invention. Indeed, no previous studies have shown such acombination of in vitro and in vivo features in islet-like structuresderived from a single isolated stem cell type. Due to their features,the pancreatic islet-like cell structures obtainable by the method ofthe present invention are particularly suitable for use in variousapplications, such as basic research, drug screening and regenerativemedicine.

Thus, in a first aspect, the invention provides a method of preparing anartificially grown spheroid pancreatic islet-like cell structure, whichcomprises the step of culturing an isolated adult stem cell in a firstdifferentiation liquid cell culture medium which comprises apoly-cationic substance.

Actually, the inventors surprisingly found that isolated adult stemcells, when cultured in a liquid cell culture medium in the presence ofa poly-cationic substance, quite early (i.e. after about 2 to 4 days)aggregate and differentiate into spheroid pancreatic islet-like cellstructures, which closely resemble naturally-occurring pancreatic isletcell structures both in size and morphology, and which are capable ofexpressing the hormones which are usually produced by human pancreaticislets (i.e. insulin, glucagon, PP, somatostatin and ghrelin).

The adult stem cell used in the method of the invention is preferably anadult mammalian stem cell. Therefore, any liquid cell culture mediumcapable of sustaining the growth of mammalian cells is suitable for usein the method of the invention. In a preferred embodiment, the liquidcell culture medium is a serum-enriched cell culture medium.Serum-enriched DMEM or RPMI are mentioned as non-limiting examples.Serum concentration in the cell culture medium is preferably comprisedwithin the range of from 5 to 20%. Preferably, the liquid cell culturemedium also comprises one or more carbon sources, such as for exampleglucose and glutamine. Preferred glucose concentrations are within therange of 6-25 mM. Preferred glutamine concentrations are within therange of 0.5-3 mM.

Within the context of the present description, the expression “adultstem cell” is intended to mean a stem cell that is isolated from anadult tissue, in contrast with an “embryonic stem cell” which isisolated from the inner cell mass of a blastocyst. Adult stem cells arealso known as “somatic stem cells”.

Any poly-cationic substance which is capable of promoting adult stemcell aggregation and differentiation into pancreatic islet cells at agiven concentration and which, at that concentration is non-cytotoxic tocells, may be used in the method of the present invention. Illustrative,non-limiting examples of poly-cationic substances suitable for use inthe method of the invention are poly-lysine and protamine.

Protamine, which is the preferred poly-cationic substance because it issuitable for clinical applications, is preferably added to the medium inthe form of a soluble salt, such as for example protamine sulfate orprotamine hydrochloride, at a concentration which preferably rangesbetween 5 and 20 mM.

In another preferred embodiment, the method of the invention furthercomprises the step of replacing the first differentiation liquid cellculture medium with a second differentiation liquid cell culture mediumnot comprising a poly-cationic substance and culturing the cells in saidsecond medium. Any liquid cell culture medium capable of sustaining thegrowth of mammalian cells is suitable for use as the seconddifferentiation liquid cell culture medium. According to a preferredembodiment, the same liquid cell culture medium which was used in thefirst step shall also be employed in the second step, except that itdoes not contain the poly-cationic substance. The aim of this step is toobtain complete maturation of the pancreatic islet-like cell structuresformed during the first step as well as their increase both in cellnumber and in structure number. Cultivation in the seconddifferentiation liquid cell culture medium is preferably carried out fora period of time of at least 2 days, more preferably for at least 10days, even more preferably for about 10 to 14 days.

As mentioned above, the presence of a poly-cationic substance in thefirst differentiation liquid cell culture medium is the key element ofthe invention, in that it accelerates the formation of spheroid cellclusters resembling islets-like structures which closely resemblenaturally occurring human pancreatic islet structures.

Indeed, as illustrated in the examples which follow, HLSCs exposure toeither DMEM or RPMI-based differentiation media (see Tables 2 and 3below), both in the presence and in the absence of glucose, did notresult in islet-like structures formation after a culture period of 4days. By contrast, the addition of protamine to either a DMEM orRPMI-based medium, both in the presence and in the absence of glucose,resulted in islet-like structures formation after a culture period of 4days (FIG. 11). Diameter of the structures derived from HLSCs iscomparable to that reported for human pancreatic islets (Chandra V etal. PLoS One. 2011; 6(6):e20615) and mostly comprised between 50 and 150um, with an average islets volume of 109±19 uM (mean±SD) (FIG. 12).

In contrast, glucose did not affect islet-like structures formation(FIG. 13A), but it plays a key role in both inducing endocrinespecification (NgN3 expression) and increasing both insulin and glucagonexpression within the structures (FIG. 13B).

According to another preferred embodiment of the invention, the adultstem cell which is differentiated into pancreatic islet-like cellstructures is an adult human liver stem cell (HLSC). A preferred humanliver stem cell is the human non-oval liver stem cell (HLSC) expressingboth mesenchymal and embryonic stem cell markers disclosed in WO2006/126219. This cell line is in particular characterised in that it isa non-oval human liver pluripotent progenitor cell line which isisolated from adult tissue, which expresses hepatic cell markers andwhich has multipotent differentiation abilities and regenerativeproperties. More in particular, this cell line is capable ofdifferentiating into mature liver cells, insulin producing cells,osteogenic cells and epithelial cells. According to a preferredembodiment, it expresses one or more markers selected from the groupcomprising albumin, α-fetoprotein, CK18, CD44, CD29, CD73, CD146, CD105,CD90 and any combination thereof, and it does not express markersselected from the group comprising CD133, CD117, CK19, CD34, cytochromeP450.

The human non-oval liver pluripotent progenitor/stem cells disclosed inWO 2006/126236 were shown to undergo differentiation into a variety oftissue cell types (namely, mature liver cells, epithelial cells,insulin-producing cells and osteogenic cells) and to exert organregenerating effects. Such cells are derived from a non-oval human liverpluripotent progenitor cell line which expresses hepatic cell markers.Such cells are isolated by a method comprising the steps of:

-   -   (i) culturing adult liver-derived human mature hepatocytes in a        cell culture medium until death of mature hepatocytes and        selection of a population of surviving cells having epithelioid        morphology;    -   (ii) expanding the population of surviving cells having        epithelioid morphology by culturing in a serum-containing,        glucose-containing culture medium supplemented with hEGF (human        epithelial growth factor) and bFGF (basic fibroblast growth        factor) and comprising the usual inorganic salts, amino acids        and vitamins necessary for the growth of mammalian cells    -   and in particular wherein the mature hepatocytes are frozen in a        serum-containing culture medium in the presence of a        cryoprotecting agent and then thawed prior to culturing        according to step (i).

The characterization of the human non-oval liver stem/progenitor cellsdisclosed in WO 2006/126236 and the method of preparing thereof areherein fully incorporated by reference.

The use of HLSCs in the present invention is preferred for a number ofreasons: 1) they are relatively easy to isolate and expand, 2) they arecharacterized by a degree of proliferation that allows to provide asuitable number of cells for therapeutic use, 3) they can be usedautologously and 4) they avoid ethical concerns. Furthermore, the liverand the pancreas share common embryonic origins and the developing liverhas been shown to exhibit transcriptional features similar to the adultpancreas (Bose B et al. Cell Biol Int. 2012; 36(11): 1013-20). However,since it is envisaged that poly-cationic substances shall be effectivein promoting aggregation and differentiation of other adult stem cellsthan HLSCs, the scope of the invention is not limited to the use ofHLSCs only, but it includes the use of any adult stem cells type.

As mentioned above, the pancreatic islet-like cells structures obtainedby the method of the present invention, are characterized by a uniquecombination of morphological and functional features which is notobserved in other islet-like cells structures prepared by the methods ofthe prior art. Accordingly, the scope of the invention also includes aspheroid pancreatic islet-like cell structure as defined in the appendedclaims.

In particular, the spheroid pancreatic islet-like cell structureaccording to the present invention is advantageously characterized by adiameter of from 50 to 250 μm, preferably of from 50 to 200 μm, which iscomparable to the naturally-occurring human pancreatic islets. It isalso characterized by a volume, expressed as IEQ/100 ILS, ranging from30 to 200 μm, preferably from 50 to 130 μM and, even moreadvantageously, by the ability to express, at the protein level, all ofthe pancreatic hormones which are usually expressed by human pancreaticislets, i.e. insulin, glucagon, pancreatic polypeptide, somatostatin andghrelin.

Within the context of the present description, IEQ/100 ILS is the IsletsEquivalent of an average diameter of 150 μm (IEQ) normalized to 100islets (ILS). According to conventional protocols, the IEQ of isletsisolated from the pancreas and used for transplantation is determined asfollows. Suspended islets isolated from the pancreas are evaluated bothin number and size (diameter) in order to determine the total isletsequivalent (i.e. total islets volume). Islets diameter assessment takesinto account 50 μm diameter range increments, from 50 μm to >350 μm,without taking into account diameters <50 μm, that do not provide asignificant contribution to the total volume. A relative conversionfactor is conventionally used to convert the total islets number toIslets Equivalent of an average diameter of 150 μm (IEQ).

Suspended islets isolated from the pancreas are separated in differentlayers based on their degree of purity. An islet sample from each layerof the final product is then analyzed: the total number of islets andthe IEQ are then calculated based on the number, the purity and the sizeof the islets, using standardized methods. Since in the context of thepresent invention the islet-like structures are obtained from culturedcells, that are adherent to the plate, the inventors assessed both thenumber and the diameter of the islet-like structures by analyzing 20010× micrographs, randomly selected, per experiment, and expressed theresults as %±SD (FIG. 12 A) and IEQ normalized to 100 islets (FIG. 12C).

Thanks to the above-illustrated features, the spheroid pancreaticislet-like cell structure according to the present invention areparticularly suitable for use both in clinical application, such as in amethod treatment of diabetes by pancreatic islet transplantation, and inin vitro applications, such as screening methods for identifyingsubstances capable of promoting the expression of one or more pancreatichormones by pancreatic islet cells or for identifying substances capableof exerting a cytotoxic effect on pancreatic islet cells.

The following examples disclose in detail the differentiation of HLSCsinto spheroid pancreatic islet-like cell structures according to thepresent invention, using protamine as the poly-cationic substance.However, the examples are not intended to limit the purpose and scope ofthe invention.

EXAMPLES 1. HLSC Culture and Expansion 1.1 Isolation, Characterizationand Culture of HLSCs

HLSCs lines are isolated from healthy liver tissues of patientsundergoing hepatectomies and characterized as previously described(Mohamad Buang M L et al. Arch Med Res. 2012; 43(1): 83-8).Specifically, HLSCs are seeded in 75 cm³ culture flasks and cultured ina medium (see Table 1) containing a 3 to 1 proportion of α-minimumessential medium and endothelial cell basal medium-1, supplemented withL-glutamine 2 mM, penicillin 100 UI/ml/streptomycin 100 μg/ml and 10%Fetal Bovine Serum. Cells are maintained in a humidified 5% CO₂incubator at 37° C.

1.2 Detachment of HLSCs

Once up to a ≈80% confluence, cells are washed twice with PBS andincubated with trypsin-EDTA 1× for about 5 minutes at 37° C., in orderto induce cell detachment. Trypsin activity is subsequently neutralizedby adding RPMI supplemented with L-glutamine 2 mM, penicillin 100UI/ml/streptomycin 100 μg/ml and 10% Fetal Bovine Serum. Then, cells areharvested by centrifugation at 1200 rpm for 5 minutes, the supernatantis removed and the pellet re-suspended in culture medium and split amongfive 75 cm³ culture flasks.

1.3 Cryopreservation of Cells

Cells up to a ≈80% confluence are detached and harvested bycentrifugation as described in paragraph 1.2. The cells are counted and10⁶ cells per vial are cryopreserved. The cell pellet is resuspended ina 1 ml solution containing 90% FBS and 10% dimethyl sulphoxide (DMSO)and placed into pre-cooled cryovial/s. The cryovials are frozen at −80°C. overnight before being placed into the liquid nitrogen container at−196° C.

1.4 Thawing of Cryopreserved Cells

A vial of frozen HLSCs is removed from the liquid nitrogen tank andplaced in a beaker of water pre-warmed to 37° C. Once the cellsuspension has completely thawed, it is placed into a sterile 50 mlfalcon tube with 10 ml of sterile media and centrifuged at 1200 rpm for5 minutes. The cell pellet is then resuspended in culture medium andsplit in three 75 cm³ culture flask and left to attach overnight at 37°C. in a humidified 5% CO₂ incubator. The medium is changed the followingday.

2. HLSC Differentiation into Islets-Like Structures.

HLSCs at a density of 12×10³/cm² are seeded in 25 cm³ culture flasks orin a Petri dish 100×20 mm in the differentiation culture medium 1 (seeTable 1) consisting in RPMI 1640 or DMEM supplemented with 10% FetalBovine Serum, glucose 11.6 mM, protamin chloride 10 μg/ml, L-glutamine 2mM and penicillin 100 UI/ml/streptomycin 100 μg/ml. Cells are placed,for a period of 4 days, without changing the medium, in a humidified 5%CO₂ incubator at 37° C. On day 5, the medium is replaced withdifferentiation culture medium 2 (see Table 3) consisting in RPMI 1640or DMEM supplemented with 10% FBS, glucose 11.6 mM, L-glutamine 2 mM andpenicillin 100 UI/ml/streptomycin 100 μg/ml. Medium is subsequentlychanged every other day. Within 2 to 4 days cells are expected to startorganizing in islets-like structures that reach a maximum number after14-18 days (FIG. 1).

TABLE 1 HLSC culture medium Final concentration Volume (ml) Final volume250 α-MEM 165 EBM 55 FBS 10% 25 Penicillin 10000 100 UI/ml/100 ug/ml 2.5UI/ml/streptomycin 10 mg/ml Glutamine 200 mM 2 mM 2.5

TABLE 2 HLSC differentiation medium 1 Final concentration Volume (ml)Final volume 250 RPMI 1640 or DMEM 216.85 FBS 10% 25Penicillin/streptomycin 100 UI/ml/100 ug/ml 2.5 Glutamine 200 mM 2 mM2.5 Glucose 1M 11.6 mM 2.9 Protamine 10 mg/ml 10 ug/ml 0.25

TABLE 3 HLSC differentiation medium 2 Final concentration Volume (ml)Final volume 250 RPMI or DMEM 217.1 FBS 10% 25 Penicillin/streptomycin100 UI/ml/100 ug/ml 2.5 Glutamine 200 mM   2 mM 2.5 Glucose 1M 11.6 mM2.9

The results obtained are illustrated in the appended drawings, thecontent of which is briefly illustrated herein below.

FIG. 1: representative 20× micrographs showing HLSCs in basal culturemedium (A) and following culture in differentiation medium withprotamine (B-D). After 24 h, the cells changed in morphology and startedforming small clusters (B) that progressively increased in both size andnumber, reaching a maximum number after a culture period of 18 days (C).(D) 40× micrograph showing islets-like structures after a culture periodof 18 days. (E) Graph showing the total number of islets-like structuresper 25 cm³ culture flask after 18 days of culture. (F) Graphrepresenting the mean±SD number of islets-like structures after 18 daysof culture (n=10).

FIGS. 2-8: representative pictures showing islet-like structurescharacterization by immunofluorescence after 14 days of culture:islets-like structures become positively stained for both PDX-1 and NgN3(FIG. 2), insulin and glucagon (FIG. 3), C-peptide and GLUT-2 (FIG. 4),somatostatin (FIG. 5), ghrelin and PP (FIG. 6), collagen IV (FIG. 7) andvon Willebrand Factor (FIG. 8).

FIG. 9: representative pictures showing immunofluorescencecharacterization of islet-like structures cells following islet-likestructures disaggregation (trypsin 1×) after 14 days of culture.

FIG. 10: graph showing both blood glucose and human C-peptide levels innon-diabetic SCID mice (solid line, CTRL), streptozotocin-induced (55mg/kg/day for 5 days) diabetic SCID mice (dotted line, DM) andstreptozotocin-induced diabetic SCID mice that received HLSC derivedislets-like structures implant (5000 IEQ/kg) under the renal capsule(dashed line, DM+ILS), before and 13 days following the implant.Compared to diabetic mice, diabetic mice that received islets-likestructures implant had a significant decrease in blood glucose levels.This was paralleled by a concomitant increase in human C-peptide, thatremained undetectable in both non diabetic SCID mice and in diabeticSCID mice that did not receive the implant.

FIG. 11: graph showing islets-like structure (ILS) formation followingHLSCs culture in RPMI or DMEM based medium supplemented with FBS 10%(F), FBS 10%+glucose 11.6 mM (FG) or FBS 10%+glucose 11.6 mM+protaminechloride 10 μg/ml (FGP) for 48 hours.

FIG. 12: graphs showing the size distribution (A), the mean±SD diameter(B) and IEQ/100 ILS (C) of islets-like structures derived from HLSCsfollowing 14 days of culture in RPMI based medium supplemented with FBS10%+glucose 11.6 mM+protamine chloride 10 μg/ml.

FIG. 13: Glucose does not affect islets-like structures (ILS) formation(A), but plays a key role in inducing endocrine specification andinsulin/glucagon expression (B). A. Representative picture and graphshowing islets-like structure formation following culture (4 days) inRPMI/DMEM supplemented with protamine chloride 10 ug/ml (P) without orwith different glucose concentrations (6, 11.6 and 28 mM). B.Representative picture showing PDX-1, NgN3, insulin and glucagonexpression in RPMI-based medium with glucose 1 or 25 mM.

FIG. 14: representative pictures showing the expression of PDX-1, NgN3,GLUT-2, C-peptide, glucagon and somatostatin in cells cultivated in apoly-lysine differentiation medium.

1-19. (canceled) 20: An artificially grown spheroid pancreaticislet-like cell structure having a diameter of from 50 to 250 μm andcomprising differentiated cells derived from an isolated adult stemcell, characterized in that it expresses at the protein level thepancreatic hormones insulin, glucagon, pancreatic polypeptide,somatostatin and ghrelin and further characterized in that thedifferentiated cells express at least the markers PDX-1 and NgN3. 21:The artificially grown spheroid pancreatic islet-like cell structureaccording to claim 20, which has a diameter of from 50 to 200 μm. 22:The artificially grown spheroid pancreatic islet-like cell structureaccording to claim 20, which has a volume expressed as IEQ/100 ILS offrom 30 to 200 μm. 23: The artificially grown spheroid pancreaticislet-like cell structure according to claim 20, which has a volumeexpressed as IEQ/100 ILS of from 50 to 130 μm. 24: The artificiallygrown spheroid pancreatic islet-like cell structure according to claim20, wherein the differentiated cells express the markers PDX-1, NgN3,C-peptide, Glut-2, collagen IV and Von Willebrand factor. 25: Theartificially grown spheroid pancreatic islet-like cell structureaccording to claim 20, wherein the adult stem cell is a human liver stemcell (HLSC). 26: A method of decreasing blood glucose levels in asubject, comprising the step of implanting into the subject at least oneartificially grown spheroid pancreatic islet-like cell structureaccording to claim
 20. 27: In a method of therapeutically treatingdiabetes in a subject by pancreatic islet transplantation, theimprovement comprising the step of implanting into the subject at leastone artificially grown spheroid pancreatic islet-like cell structureaccording to claim
 20. 28: The use of an artificially grown spheroidpancreatic islet-like cell structure according to claim 20, in an invitro screening method for identifying substances capable of promotingthe expression of one or more pancreatic hormones by pancreatic isletcells or for identifying substances capable of exerting a cytotoxiceffect on pancreatic islet cells.